MEDICARE: TANEETA MINDY GANGULY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084E0001X	Epilepsy Physician	MD467235	PA

General Provider Information

NPI Number	:	1043698673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANEETA MINDY GANGULY MD

Provider Business Mailing Address
First Line	:	3400 SPRUCE ST
Second Line	:	3 DULLES
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-5127
Country	:	US
Telephone Number	:	215-662-3606
Fax Number	:	215-349-5579

Provider Business Practice Location Address
First Line	:	3400 SPRUCE STREET
Second Line	:	2 RAVDIN
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-4206
Country	:	US
Telephone Number	:	267-760-7857
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2015
Last Update Date	:	12/04/2025

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